妇科急腹症的CT诊断

CT Diagnosis of Gynecological Acute Abdomen

目的探讨妇科急腹症的CT表现,以提高对妇科急腹症的CT诊断水平。方法对35例妇科急腹症患者的临床资料及影像学资料进行回顾性分析。结果 35例患者中CT诊断为急性盆腔炎12例,表现为附件增粗及盆腔积液;盆腔脓肿4例,表现为子宫直肠陷窝囊性密度减低区,周边呈渗出样改变,边界模糊,增强扫描呈环形边缘强化,囊内低密度区无强化;异位妊娠及黄体破裂出血各6例,表现为子宫直肠陷窝或附件区类圆形混杂密度包块,边界不清,CT值为42～65 HU,增强扫描见包膜强化,囊内密度未见增高,并见盆腔内积液;子宫内膜异位4例,位于附件区,表现为不均匀混杂密度囊性病变,呈壁薄、多房性,边界不清,增强扫描囊壁呈不规则多环形强化;卵巢囊腺瘤蒂扭转并出血3例,CT表现为单房或多房囊性肿块,囊壁薄均匀,内见高密度积血影沉积,CT值为40～75 HU,增强扫描囊壁强化,囊内密度未见增高。结论妇科急腹症中进行CT检查对临床定性诊断可以起到明显的辅助作用,能多方位显示盆腔组织器官解剖结构关系及病理变化表现,能快速诊断急性病因,可作为除育龄期女性及儿童外大多数女性患者的首选检查方法。

Objective To investigate the CT features of gynecological acute abdomen, and to improve the diagnosis of gynecological acute abdomen. Methods The clinical and imaging data of 35 patients with gynecological acute abdomen were analyzed retrospectively. Results CT scans showed adnexal thickening and pelvic effusion in 12 patients with acute pelvic inflammation, cystic low density area in uterus rectum lacuna, pericardial effusion, enhancement in intracapsular low density area in fuzzy boundaries, annular edge enhancement and no 4 patients with pelvic abscess, round mixed density mass in uterus rectum lacuna and attachment area （42-65 HU）,fuzzy boundaries, envelope enhancement, pelvic effusion and no intracapsular density enhancement in 6 patients with ectopic gestation and corpus luteum rupture, unevenly mixed density cystic lesion with thin-walled and multi- room structures, fuzzy boundaries and irregular multi-ring enhancement in 4 patients with endometriosis, and single or multiple room cystic mass with uniform thin-wailed structures, high- density hematocele （40-75 HU）, cyst wall enhancement and no intracapsular density enhancement in 3 patients with hemorrhagic ovarian cystadenoma torsion. Conclusion CT scan plays a supporting role in the clinical diagnosis of gynecological acute abdomen. It can comprehensively display the anatomical structures and pathological changes of pelvic tissues and organs and quickly diagnose the cause of gynecological acute abdomen. Therefore, CT scan can be used as the preferred method for clinical diagnosis of gynecological acute abdomen in most patients except childbearing age women and children.